Endocrine

Question 1

Treatment strategy includes:

Low-sugar diet

Insulin replacement

Answer 1

Type I DM

Question 2

Treatment strategy includes:

Dietary modification and exercise for weight loss

Oral hypoglycemics

Insulin replacement

Answer 2

Type II DM

Question 3

Bind insulin receptor (tyrosine kinase)

Glycogen storage in liver, glycogen/protein synthesis and K+ uptake in muscle, TG storage in fat

For type I and II DM, gestational diabetes, life-threatening hyperkalemia, stress-induced hyperglycemia

Hypoglycemia, hypersensitivity

Answer 3

Insulin

Rapid: lispro, aspart, glulisine

Short: regular insulin

Intermediate: NPH

Long: glargine, detemir

Question 4

Unknown mechanism

Increased glycolysis, peripheral glucose uptake, decreased gluconeogenesis

First-line: type II DM

Good for pt without islet function

GI upset, lactic acidosis

Contra: renal failure

Answer 4

Biguanide:

Metformin

Question 5

Increases islet beta-cell depolarization by closing K+ channel

V-gated Ca2+ influx = insulin efflux

For DM II

need some islet function (not good for DM I)

1st gen (2): disulfiram-like effects (EtOH avoidance)

2nd gen (3): hypoglycemia

Answer 5

Sulfonylureas:

1st: Tolbutamide, chlorpropamide
2nd: Glyburide, glimepiride, glipizide

Question 6

Binds PPAR-gamma nuclear transcription regulator

Increased insulin sensitivity in peripheral tissues

For DM II

Weight gain, edema, hepatotoxicity, heart failure

Answer 6

Glitazones/thiazolidinediones:

Pioglitazone, Rosiglitazone

Question 7

Inhibits alpha-glucosidases at intestinal brush-border

Delays glucose absorption, decreases postpradial hyperglycemia

For DM II

GI disturbances

Answer 7

alpha-glucosidase inhibitors:

Acarbose, miglitol

Question 8

Decreases glucagon

For DM I and II

Hypoglycemia, nausea, diarrhea

Answer 8

Amylin analog:

Pramlintide

Question 9

Increases insulin, decreases glucagon release

For DM II

Nausea, vomiting, pancreatitis

Answer 9

GLP-1 analogs:

Exenatide, liraglutide

Question 10

Increases insulin, decreases glucagon release

For DM II

Mild urinary or respiratory infections

Answer 10

DPP-4 inhibitors:

Linagliptin, saxagliptin, sitagliptin

Question 11

Gene which regulates:

Fatty acid storage

Glucose metabolism

Causes increase in insulin sensitivity, levels of adiponectin

Answer 11

PPAR-gamma

Question 12

Block peroxidase (2)

Inhibits organification of iodide, coupling to thyroid hormone

Blocks 5’-deiodinase (1)

Decreased peripheral conversion of T4 -> T3

For hyperthyroidism

Skin rash, agranulocytosis (rare), aplastic anemia, hepatotoxicity (1), teratogen (1)

Answer 12

Propylthiouracil (both, hepatotoxic)

Methimazole (only peroxidase, teratogen)

Question 13

Thyroxine replacement (2)

For hypothyroidism, myxedema

Tachycardia, heat intolerance, tremors, arrhythmias

Answer 13

Levothyroxine, triiodothyronine

Question 14

For GH deficiency, Turner syndrome

Answer 14

Growth Hormone

Question 15

For acromegaly, carcinoid syndrome, gastrinoma, glucagonoma, esophageal varices

Answer 15

Somatostatin

(octreotide)

Question 16

Stimulates labor, uterine contractions, milk let-down, controls uterine hemorrhage

Answer 16

Oxytocin

Question 17

Pituitary (central) diabetes insipidus

NOT nephrogenic DI

Answer 17

ADH (desmopressin)

Question 18

ADH antagonist

For SIADH

Nephrogenic DI, photosensitivity, abnormalities of bone and teeth (tetracycline family)

Answer 18

Demeclocycline

Question 19

Inhibit phospholipase A2, expression of COX-2

Decreased production of leukotrienes and prostaglandins

For Addison’s disease, inflammation, immune suppression, asthma

Iatrogenic Cushing’s syndrome, adrenal insufficiency after chronic use.

Answer 19

Glucocorticoids:

Hydrocortisone, prednisone, triamcinolone, dexamethasone, beclomethasone